PROFESSIONAL

Clinical handover and

patient safety
Australian health care providers are being urged by peak health organisations
to focus on the importance of effective clinical handover protocols in order to
improve patient outcomes.
The push comes at a time when, according to the World Health Organization
(WHO), one in 300 patients is harmed while receiving medical carea safety
record that is worse than the aviation and nuclear industries. QNU Professional
Officer Chris Jensen reports:

Peak body recommendations

The Australian Commission on Safety
and Quality in Health Care (ACSQH)
has been appointed by the World Health
Organization to identify solutions and
monitor outcomes regarding patient
safety across Australia as part of the
High Fivesprevention of patient care
handover errors initiative.
ACSQH has listed the clinical handover
process as one of their top priorities
in reducing adverse patient events.
They have recently produced protocols
for bedside nursing and whiteboard
handover, and they are now available
on their website at
www.safetyandquality.gov.au.
The recently released Australian
Health Care and Hospitals Association
(AHHA) 2009 Issues Paper Clinical
HandoverSystem Change, Leadership
and Principles contains a number of
relevant recommendations regarding
clinical handover.
These recommendations include
a need for a minimum data set for
use in public and private hospital
and community settings; a need
for systemic culture change within
an organisation to improve clinical
communication; and incident
reporting.
Both the WHO and the AHHA refer
to the economic benefits of improving
patient safety. The AHHA goes further,
specifically referring to the danger of
clinical handover being relinquished
for perceived efficiency savings,
18 | tqn | February 2010

referring to the perception of clinical

handover time being seen as better
used for direct care.

starting a shift and that the content of

the transferred information often lacks
any standardisation.

Meanwhile the Garling Report,

conducted in NSW, analysed the
importance of communication and its
impact on patient safety.

The use of casual, agency and pool

staff, short shift changeovers, varying
shift start times and patient throughput
further increases the need for more
accurate and timely exchanges of
information in the handover process.

It determined that, in spite of a number

of initiatives to improve clinical
handover practices, they had not yet
delivered a system wide improvement.
Report recommendations included that
hospital policy requires a mandatory
shift handover with a minimum data
set and that some parts of handover are
conducted at the patients bedside.
Other recommendations included
ensuring sufficient time is rostered to
allow for a complete handover and
a requirement for electronic written
records to be made of all handovers.

The reality

In spite of the recommendations

of leading organisations and recent
research confirming the significance
of clinical handovers in achieving
safe patient outcomes, many facilities
continue to consider time spent on
handover as less important than, or
even separate to, patient care.
As nursing professionals, we know that
too often in reality insufficient time
is allocated to the handover process
to actually enable all the relevant
information to be conveyed.
We also know there is usually precious
little time to review patient files when

Increased patient acuity results in the

need for inclusive information to be
communicated with patients and their
families more often.
Clinical handover is sometimes ad
hoc, not reported by the actual carer,
hurried to allow staff to leave on time
or is a mere conversation focusing on
irrelevant information.

What is required

Clinical leadership is needed more

than ever before if clinical handover is
to achieve the workplace significance
recommended by peak health
organisations.
Those in charge of shifts should receive
a handover about all patients within
their area, not just those in their direct
care. This added responsibility also
needs to be recognised by the employer.
Language and literacy skills also need
to be considered if workplaces are
seeking to use verbal handovers* or
written material.
Appropriate time needs to be rostered
to ensure a proper handover includes
the opportunity to review the relevant
www.qnu.org.au

PROFESSIONAL

file and records

and seek
any additional
enrolment nomination
enrolment
information
information Who
orcanfollow
up care.
attend?

Course title:

All QNU members can attend our union training courses. QNU courses aim
to equip members to further develop the necessary skills and knowledge
required by employees to participate in and effectively contribute to
workplace change.

Course dates:

Records should be kept of the actual

information provided during the
clinical handover as core nursing
handover for future reference and all
and midwifery business essential
What does it cost?
discussion during the handover process
to safe patientthe
care.
industrial,
ing
Paid leave provisions
public sector:care.
promoting and defend
should be relevant
to patient
Roster staff on overlapping shifts
to ensure
they have adequate time
A standard format should be considered professional,
social,
for a comprehensive handover.
to ensure the most relevant information
is communicated to those responsible political and
Ensure
democrthat
atic efficient information
Paid leave
private sector:
for patient care
at provisions
the appropriate
time
and IT systems are in place to
using the most effective method.
support the handover.
How to enrol
Provide adequately equipped
Further research is also needed in the
and interests
work spacesvalues
for handover.
area. This includes research into the
of me
mbers
effectiveness of electronic records and
Make sure staff are not
called
Child care
tracking systems as well as the influence
away during handover, except in
of workplace cultural and clinical
an emergency.
Travel & accommodation
contexts on the
content and accuracy of
Consider patient involvement in
information contained in the handover.
the handover.
(07) 3840 1444 or 1800 177 273
Workplace policies regarding clinical
Provide
in-service
www.qnu.org.au and training on
handover need to include ongoing staff
appropriate handover techniques.
education as well as active research to
Initiate a research project in your
achieve best practice.
workplace examining handover
best practice.
* In both the draft standards developed by
the ACSQH and the Queensland Health Patient
Keep the handover conversation
Safety Centres Clinical Handover A Strategy
objective.
Options Paperdraft report, taped handover is not
Retain formal records of the
recommended.
handover information for future
** National standards for clinical handover are
reference.
currently under development by the ACSQH.
All QNU courses recognise the needs of nurses as employees.

Location of course:

Actions to take in your

workplace**
Consider the time taken for

JanUarY - JUne 2010

QNU members in management positions who are seeking information and

education to further develop their understanding of industrial issues from
a management perspective should contact their employer for information
regarding appropriate management training programs.

Name:
Address:

Postcode:

Phone No: (h)

There is no cost, QNU training is included in your union membership. The

following leave provisions apply.

(w)

Mobile:
Email:

All nurses working in the public sector are entitled to PAID leave. This
provision allows for members to attend Trade Union Training for up to 5
working days per calendar year (refer to IRM 11.5-4 Industrial Relations
Education Leave).

Membership No:
Workplace:

This leave can not be unreasonably refused by your employer. This leave
is not Conference Leave, it is specifically for Industrial Relations Education
Leave.

Current position:
Unit:

Employer category: (please tick)

Public Hospital

Private Hospital

Community

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Other: (please specify)

Aged Care

All members are entitled to this Leave as part of their current employment
conditions. If you experience any difficulty getting paid Industrial
Relations Education Leave, contact your QNU Organiser or the Training
Unit immediately.

Many agreements in the private sector have provisions for education for
employees who are union members. For specific information about your
entitlements call the QNU Member Servicing Centre on (07) 3840 1444 or
the QNU Training Unit on (07) 3840 1431.

Nursing classification

Did you apply for paid leave from your employer to attend?
Yes

No

Was it granted?
Yes

No

Not advised

Position held in QNU:

(eg Workplace Rep, Branch Official, Member)

How long held?

Complete the attached enrolment form and send it to the Brisbane

Office as soon as possible GPO Box 1289, Brisbane Q 4001 OR Fax
(07) 3217 2794. To ensure a place on the course send your enrolment
in to the QNU now and apply for leave from your employer at the
same time. Members can now enrol by logging onto the QNU website:
www.qnu.org.au
If you are unable to attend, please notify us promptly.

Do you require accommodation?

Yes

No

Which nights do you require?

Should child care be required, please contact the Training Unit as soon as
possible on (07) 3840 1431.
Child care assistance will generally only be available on the basis of
reimbursement of additional costs.

Do you require assistance with travel?

Yes

No

The QNU Training Unit will contact you regarding

your travel arrangements.

IMPORTANT PLEASE RETURN THIS FORM TO THE QNU

AS SOON AS POSSIBLE. Enrolments should be received 10 days

before commencement of the course. Should you experience delays
in receiving employer advice concerning approval of paid leave,
accommodation or travel assistance, contact the QNU ASAP.
Send enrolments to:
QNU
GPO Box 1289, Brisbane Q 4001 or
Fax (07) 3217 2794

Members requiring travel or accommodation assistance in order to

participate should, in the first instance make application to their employer
as some courses may be funded by the employer. Requests for QNU
assistance with travel, accommodation or child care must be made prior
to the commencement of the course, by contacting the QNU Training Unit
on (07) 3840 1431 or toll free 1800 177 273. Child care assistance will
generally only be available on the basis of reimbursement of additional
costs.

Queensland Nurses Union of Employees,

187 Melbourne Street, West End Q 4101

For more information please contact Helena Dalton-Bridges, Education

Officer, in the QNU Brisbane Office on (07) 3840 1431 or toll free
1800 177 273, or speak to your Union Organiser.

Authorised by G.Hawksworth, Secretary Queensland Nurses Union of Employees, December 2009

Want to keep nursing beyond 30 June 2010?

With national registration due to commence on 1 July this year, nurses and
midwives will need to register with the Queensland Nursing Council before
that date to be automatically registered in the new system.
If you wish to continue practising nursing and/or midwifery from 1 July then
you must renew your annual licence certificate between 1 April and 30 June
2010. This licence will be recognised nationally under the Australian Health
Practitioner Regulation Agency (AHPRA). It will then be renewed annually
under AHPRA from 2011.
Make sure your details are up-to-date for when your renewal notice is mailed
in early April. You can also renew your licence online at www.qnc.qld.gov.au
Nurses and midwives who renew early can win one of three prizes.

Renew by 30 April 2010 and go in the draw to win one of two $1000.00 cash
prizes.

Renew by 31 May 2010 and go in the draw to win one of two $500.00 cash
prizes.

Renew before 31 May 2010 and go into the draw to win one of 10 Family
World Passes to Dreamworld & WhiteWater World.

For all renewal enquiries, please contact the QNCs Client Service centre
during office hours from Monday to Friday on 07 3223 5100 or email
registrations@qnc.qld.gov.au with Renewals in the subject line.
www.qnu.org.au

Knowing your entitlements and understanding the

award24-25 February; Brisbane
Workplace Representatives 12, 3 & 4 March;
Brisbane
Handling grievances in the workplace8 March;
Brisbane
Are Queensland Health Consulting?How to stop
the rot when theyre not!9 March; Brisbane
Workplace Representatives 116, 17 & 18 March;
Darwin
Are Queensland Health Consulting?How to stop
the rot when theyre not!23 March;Townsville
Handling grievances in the workplace24 March;
Townsville
Political and Community CampaigningHow to
make a difference!25 March; Townsville
Private Hospital NursesCurrent issues and how to
address them!30 March; Brisbane
Creating a safe workplace (WH&S)31 March;
Brisbane
QNU Branch Development 1Establishing,
developing and growing our voice13-14 April;
Brisbane
QNU Branch Development 2Establishing,
developing and growing our voice15 April; Brisbane

TO ENROL IN ANY OF THESE COURSES

download a nomination form from the QNU website
(www.qnu.org.au) OR

contact your local QNU office and ask them to send you
a form OR

ring the Training Section in Brisbane on 3840 1444 or

1800 177 273

February 2010 | tqn | 19

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